Provider Demographics
NPI:1447897566
Name:SAMPSON, YVETTE
Entity type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3313
Mailing Address - Country:US
Mailing Address - Phone:856-336-9920
Mailing Address - Fax:
Practice Address - Street 1:3113 W DAKOTA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3313
Practice Address - Country:US
Practice Address - Phone:856-336-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200031813376K00000X
200031813376K00000X
NJNA200031813376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide